Improvement of tuberculosis case detection and reduction of discrepancies between men and women by simple sputum-submission in

Background Detecting patients whose sputum is smear-positive (smear+) on microscopic examination is an essential public health strategy to control tuberculosis (TB). It is estimated that only 53% of smear+ cases were notified under DOTS in 2004, indicating that a significant proportion of smear+ cases are going undetected within DOTS areas worldwide. Recent studies have suggested that women in particular are at risk of under-detection as they test smear+ less often than males. At the Federal TB Centre in Rawalpindi, Pakistan, specimens from female patients tested smear+ only half as frequently as specimens from men. A review of laboratory registers indicated that women submitted more salivary specimens than men. We hypothesised that submission of poor quality sputum specimens by women may be one reason for the gender difference in smear results.